Occupational Health Questionnaire

Personal Information

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Thank you for taking the time to complete this occupational health questionnaire. The purpose of this questionnaire is to help identify any potential occupational health risks that may affect your wellbeing in the workplace. The information you provide will be kept confidential and used solely for the purpose of assessing your occupational health needs. Please answer all questions truthfully and to the best of your ability.

1. What is your name?

 

2. What is your age?

 

3. What is your gender?

 

4. What is your occupation?

 

5. How long have you been in this occupation?